Larchmere House Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Before people moved into the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person. The assessment included making sure that support was planned for people’s diversity needs, such as their religion, gender, marital status, culture and their abilities. Each person’s care plan and assessments were also reassessed once a month as part of the ‘resident of the day’ process. This ensures that every person’s care plan and risk assessment is updated at least monthly. People were reassessed as their needs changed to ensure the care they received met their needs. Some assessments included information about what people could do for themselves. People told us they were involved in their assessments and care planning processes. Some relatives told us they had been involved in the assessment and care planning process when their family member first moved to the service. A relative said, “They spoke to mum and us about likes, dislikes, care needs, food likes etc.” Staff told us important information and changes to people’s care needs were passed on at handover meetings and documented in handover notes on the electronic system.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Whilst we observed people being offered drinks, we found fluid charts were not completed for people who were at risk of dehydration. Some people were not having enough fluid to keep them healthy in accordance with NHS good practice guidance. Some people were regularly sleeping for long periods of time during the day and staff had been recording that they had not eaten or drunk. Staff told us, “It is hit and miss with getting drinks in [person] sometimes they drink well other times not, especially when sleepy.” They explained the person had not had any fluids at all on the day of our assessment. The registered manager told us, “We have decided to put fluid watch in place for our most vulnerable residents, as in the unlikely event that all our own staff were sick and a group of agency staff had to run the home then they wouldn’t know the residents and what is normal for them.”

Care plans and risk assessments clearly described what modified diet people were prescribed and the care plans followed The International Dysphagia Diet Standardisation Initiative (IDDSI) framework. The guidance was also available in the kitchen for staff responsible for preparing, cooking and serving meals. Kitchen staff and those responsible for supporting people with their food had a good understanding of people’s assessed needs in relation to type and texture of food as well as any allergies and food intolerances. Staff told us they helped people to make their meal choices if they needed it. A person said, “We get 2 choices, they show both plates, so you know what you are getting.” We observed kitchen staff asking people what food choices they would like. We received positive feedback about the food. Comments included, “Food is very good, they try and feed you up, food looks lovely on the plate. I asked for a baked apple, it was lovely but only once. I get my prunes for breakfast every day, everyone can ask what they want for breakfast. I had bacon, sausage and mushrooms. I have had some lovely breakfasts. I get a choice of 2 main meals like a roast or salad, we choose half an hour before, occasionally I go to the dining room and meet a friend”; “Have super salads, always nice freshly cooked carrots, peas and cauliflower, they are good on veg, get nice beef”; “Food is very good, got our own cook. I love the roasts, have as many fruits and vegetables as we want, get drinks with our meals, always got a bottle and a glass of water at all times” and “Food is very good, there are always drinks up here for me, they leave me lots of cold drinks, they give me too much food, I asked for a sandwich today.” A relative said, “[Person] loves her food. I had Christmas dinner here last year it was nice.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. The provider had a clear process in place to escalate health concerns within a timely manner. People’s care plans included hospital passports. Staff worked with health professionals to ensure people got the care and support they needed. Health professionals told us that there had been some issues between the GP surgery and the service. However, these had largely been resolved through clarification over how patient care was to be managed.

The registered manager and nurses told us, they worked with the local hospice when people were at end of life, to seek advice and support. Nursing staff and other staff told us there were good links with other health professionals such as SaLT (Speech and Language Therapy), physiotherapy, the GP, TVN (Tissue Viability nurse). Trained nurses within the service reviewed and updated people’s clinical records daily if they required nursing care. People told us staff worked with GP’s and health professionals to meet their health needs. A person said, “Doctor has seen me occasionally, they speak to the local surgery, and she comes and sees those on the list.” A relative said their loved one had been unwell and had been prescribed antibiotics. They said, “Nurses were good and keep me informed.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People told us they were supported with their healthcare. People said, “The chiropodist came last Friday, fingernails; one of the girls did them for me and did a good job” and “[Staff member] took me to the dentist.” The GP carried out a weekly visit to the service. People living at the service had access to onsite nurses employed by the provider and other health care professionals, for example, the community mental health team, chiropody, dietician, dentists and SALT (Speech and language therapists). The registered manager said, “We do have an occasional visiting dentist. We did have a private dentist also visit.” Visiting was encouraged and people were supported to attend medical appointments. Staff had a good understanding of meeting people’s changing needs. A staff member told us, “If blood sugars are low everything might change, such as they are acting differently, I would discuss with the nurse.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Staff worked together as a team to support people and to ensure people received their care and support in the way they chose. A person said, “It is good here, the girls (staff) seem to be very happy, and they get on with each other.” Staff also recognised when people’s relatives needed help and support. A relative told us, “The home supports me.” Another relative said, “He is part of a family, lots of the staff have been here for years and they are so supportive of me.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. We checked whether the service was working within the principles of the Mental Capacity Act (MCA), whether appropriate legal authorisations were in place when needed to deprive a person of their liberty. The service worked within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. When people were assessed as lacking capacity to make decisions appropriate procedures were followed to ensure principles within the MCA were followed. Decisions made were appropriately documented to demonstrate who had been involved in the decision. People had signed consent forms within their care records. Deprivation of Liberty Safeguards (DoLS) applications and authorisations were in place for people around any restrictions within their lives that they did not have capacity to consent to. Systems to review these were also in place.

People's ability to consent to care and support had been assessed. Care was person centred, people were offered choices throughout the day, and most people told us they felt listened to and their views and opinions were important to staff. A person said, “I am fairly independent, get up and go to bed that’s my choice, go when I want, I can shut my door.” A relative explained that their loved one had capacity to make their own choices and decisions such as whether to have vaccinations.